POS1202-HPR ADDRESSING AXSPA DIAGNOSTIC DELAY BY IMPLEMENTATION OF ASYNCHRONOUS TELEMEDICINE AND MEDICAL STUDENT-SUPPORTED VISITS
Authors: H. Labinsky, S. Von Rohr, B. Horstmann, F. Seese, F. Muehlensiepen, K. Boy, M. G. Raimondo, I. Gehring, J. Rojas-Restrepo, E. Vogt, A. Ramming, M. Schmalzing, G. Schett, J. Knitza
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Axial Spondyloarthritis (axSpA) has one of the longest diagnostic delays in rheumatology [1]. Telemedical solutions and integration of medical students to support routine care may be promising to overcome current limitations and accelerate axSpA diagnosis and treatment. <h3>Objectives</h3> We aimed to test a novel diagnostic pathway and asynchronous report-based diagnostic assessments for patients with suspected axSpA. <h3>Methods</h3> 40 patients with chronic back pain for more than 3 months completed a pre-appointment visit (T-1) with a medical student prior to their planned actual first visit (gold standard, T0) (Figure 1). Findings were discussed with a rheumatologist to finalize diagnostics and initiate therapy. Patients also completed two digital symptom checkers (SC), started to continuously report ePROs (BASDAI) via an app and received upper-arm self-sampling devices to self-collect capillary blood at home for remote C-reactive protein (CRP) and HLA-B27 analysis. Two additional students and three additional tele-rheumatologists reviewed SC, laboratory and imaging results to investigate an asynchronous telemedical diagnostic approach. Acceptance was measured using the net promoter score (NPS) [2]. For this, patients were asked to rate on an 11-point scale ranging from 0 ('Very unlikely') to 10 ('Very likely') how likely they would recommend the applications to others. To calculate an overall NPS, the percentage of detractors (rating 0-6) was subtracted from the percentage of promoters (rating 9 or 10). <h3>Results</h3> N=36 patients completed the study. AxSpA was confirmed in 17 and ruled out in 19 cases. The student visit helped to complete diagnostic evaluations prior to the actual first visit and the diagnostic delay (T-1,T0) was significantly reduced by about two months (Med (IQR), 55.5 (67.3) days, p &lt;0.0001). The diagnostic accuracy (DA, axSpA yes or no) for the two SC Ada and bechterew-check was 58% and 47%, respectively. The student with patient contact reached a DA of 86%, the mean DA ± SD of the students who did not have patient contact (asynchronous decision) was 75% ± 0%. Results of the three tele-rheumatologists showed a high sensitivity (98% ± 3%) and diagnostic accuracy (89% ± 3%). Imaging results turned out to be an essential part for asynchronous decision making, as they significantly increased the sensitivity of the decision of all three physicians. Unsupervised at-home self-collection of capillary blood was successfully conducted by 80% of the patients. For the first time, accuracy of self-sampled HLA-B27 was demonstrated. Patients expressed high acceptance regarding the pre-appointment student visit, self-sampling and ePRO, with NPS of +62%, +36% and +31%, respectively. <h3>Conclusion</h3> To our knowledge, this is the first study exploring the potential of self-sampling, medical students and asynchronous assessments to accelerate axSpA diagnosis. The investigated elements were well accepted among patients and significantly reduced axSpA diagnostic delay. <h3>References</h3> [1] Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2021 Apr 6;60(4):1620-1628. doi: 10.1093/rheumatology/keaa807. PMID: 33428758. [2] Reichheld FF. The one number you need to grow. Harv Bus Rev. 2003 Dec;81(12):46-54, 124. PMID: 14712543. <h3>Acknowledgements</h3> This study was partially supported by Novartis GmbH. <h3>Disclosure of Interests</h3> Hannah Labinsky: None declared, Sophie von Rohr: None declared, Britta Horstmann: None declared, Felix Seese: None declared, Felix Muehlensiepen: None declared, Katharina Boy: None declared, Maria Gabriella Raimondo: None declared, Isabel Gehring Employee of: Thermo Fisher Scientific, Jessica Rojas-Restrepo Employee of: Thermo Fisher Scientific, Ekaterina Vogt Employee of: Thermo Fisher Scientific, Andreas Ramming: None declared, Marc Schmalzing: None declared, Georg Schett: None declared, Johannes Knitza Consultant of: Abaton and Novartis GmbH, Grant/research support from: Abaton and Novartis GmbH.